title: Shedding light on junior doctors' work practices after hours.
abstract: BACKGROUND
  It is imperative to understand the current work practices of hospital personnel to inform efforts and secure resources towards the improvement of hospital systems. Research examining doctors' work during night-shifts is limited.
  
  
  OBJECTIVE
  To describe and quantify the night-shift work practices of junior doctors.
  
  
  METHODS
  An observational time and motion study was conducted. Eight resident doctors in four general wards were observed for 96 h during night shifts (Monday-Friday, 2200-0800).
  
  
  RESULTS
  Doctors spent the highest proportion (28%; 95% CI 21-35) of their time performing social/personal tasks (e.g. sleeping, eating) and indirect care (24%; 95% CI 22-25) (e.g. reviewing notes, ordering tests). Work-related discussion comprised 15% (95% CI 13-17), and most took place at the beginning of the night. Medication-related tasks consumed a small proportion of time (4%; 95% CI 3-4) but attracted a higher level of multitasking and interruptions than most other tasks. On average, 2 h of every shift were spent at a computer and 1.3 h with patient notes. Doctors spent 72% of the night-shift alone, multitasked 6.4% of the time and were interrupted, on average, once every 46 min.
  
  
  CONCLUSIONS
  This study provides new data about junior doctors' work at night. Relative to doctors during the day, greater proportions of time were devoted to social/personal tasks (including sleep) and indirect care, but a similar proportion to direct care. Multitasking and interruptions were minimal. Computer activities were an integral part of work. Handovers were observed at the beginning but not the completion of the night shift, which may have implications for patient safety.
authors.affiliation: UNSW Medicine, University of New South Wales, Sydney, New South Wales, Australia.
authors.forename: P N
authors.initials: PN
authors.lastname: Arabadzhiyska
authors.forename: M T
authors.initials: MT
authors.lastname: Baysari
authors.forename: S
authors.initials: S
authors.lastname: Walter
authors.forename: R O
authors.initials: RO
authors.lastname: Day
authors.forename: J I
authors.initials: JI
authors.lastname: Westbrook
mesh_terms: D006784:Hospitals, Teaching / Q000379:methods / Q000706:statistics & numerical data*; D006801:Humans; D008505:Medical Staff, Hospital / Q000523:psychology / Q000706:statistics & numerical data*; D013997:Time Factors; D013996:Time and Motion Studies; D014940:Work Schedule Tolerance / Q000523:psychology
keywords: junior doctor; night-shift; time and motion; work practice